Provider Demographics
NPI:1417355090
Name:BLUE RIDGE HEARING GROUP
Entity Type:Organization
Organization Name:BLUE RIDGE HEARING GROUP
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:540-444-5659
Mailing Address - Street 1:12925 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:STE.202
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-3971
Mailing Address - Country:US
Mailing Address - Phone:540-444-5659
Mailing Address - Fax:540-301-1167
Practice Address - Street 1:12925 BOOKER T WASHINGTON HWY
Practice Address - Street 2:STE.202
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-3971
Practice Address - Country:US
Practice Address - Phone:540-444-5659
Practice Address - Fax:540-301-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001696332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment